Sloan Chad S, Hon Heidi H, Figy Sean C
Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Nebraska Medical Center, Omaha, Nebr.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Nebr.
Plast Reconstr Surg Glob Open. 2023 Mar 13;11(3):e4859. doi: 10.1097/GOX.0000000000004859. eCollection 2023 Mar.
Lymphatic leaks are a rare phenomenon, but can be a troublesome and persistent problem, especially in an already debilitated patient. Historically, management of lymphorrhea has involved non- and minimally-invasive techniques of elevation, compression, aspiration, or drain placement, among others. Ligation and sclerotherapy are additional utilized techniques, directly targeting the lymphatic vessel. Microsurgical management of lymphatic leaks via lymphaticolymphatic and lymphaticovenous anastomosis has gained popularity amongst surgeons as an alternative solution to the problem. We present a patient who developed a high-output lymphocutaneous fistula after a femoral cannulation procedure for cardiopulmonary bypass for an orthotopic heart transplantation. After multiple unsuccessful attempts at traditional management options, the patient had a successful resolution of the high-output lymphorrhea via a lymphaticovenous anastomosis utilizing end-to-end coaptation with an interpositional vein graft. This case uniquely describes a lymphaticovenous anastomosis and bypass of a lymph node in the setting of significant lymphorrhea (>1.0 L per day) and associated lymphocutaneous fistula, that was effectively managed in the acute postoperative setting. Management of lymphorrhea by microsurgical techniques and lymphatic vessel manipulation in the postoperative period provides surgeons with an enhanced option for direct operative management of lymphatic vessels and their associated sequelae.
淋巴漏是一种罕见现象，但可能是一个棘手且持续存在的问题，尤其是在本就虚弱的患者中。从历史上看，淋巴漏的管理涉及抬高、压迫、抽吸或放置引流管等非侵入性和微创技术。结扎和硬化疗法是另外使用的技术，直接针对淋巴管。通过淋巴管-淋巴管吻合术和淋巴管-静脉吻合术对淋巴漏进行显微外科治疗，作为该问题的一种替代解决方案，已在外科医生中受到欢迎。我们报告一名患者，在进行原位心脏移植的体外循环股动脉插管术后出现高流量淋巴皮肤瘘。在多次尝试传统管理方法均未成功后，该患者通过使用端对端吻合和间置静脉移植物的淋巴管-静脉吻合术，成功解决了高流量淋巴漏问题。本病例独特地描述了在大量淋巴漏（每天>1.0升）和相关淋巴皮肤瘘的情况下进行的淋巴管-静脉吻合术以及绕过一个淋巴结的情况，在术后急性期得到了有效处理。术后通过显微外科技术和淋巴管操作来管理淋巴漏，为外科医生提供了一种增强的直接手术管理淋巴管及其相关后遗症的选择。
